Topic 4: Installation Stage

New programs or practices are not yet being delivered during the Installation Stage.  Rather, this is when needed organizational and personal competencies are established to ensure the successful implementation of the selected innovation.  After making a decision to begin implementing a new practice or innovation, there are tasks that need to be accomplished before the change in practice actually begins.  These activities reflect the Installation Stage of implementation.  Activities during the Installation Stage create the infrastructure and make the instrumental changes necessary.

Implementation Teams

During the Installation Stage, Implementation Teams actively build their own capacity to support the implementation of selected innovations. They partner with program developers, external consultants, and intermediary organizations to ensure they have the competencies needed to support and sustain implementation at the staff level as well as at the organization level. At this stage, implementation teams work together to assure the availability of resources necessary to initiate the project, including the development of the implementation infrastructure.

Organization managers often think of innovations as “plug and play” and are surprised by the need for preparation and resources.  Many attempts to use evidence-based programs end at the Installation Stage when the lack of resources becomes evident.  Implementation Teams help organizations anticipate these needs and help them prepare for the next Stage.

Implementation Teams actively develop the supports needed to initiate the new practice and use it as intended.  Teams put necessary organizational supports into place (e.g., funding, human resource strategies, new policies and procedures, materials).  They create referral mechanisms, reporting frameworks and outcome expectations.  And importantly, they create and install the supports needed to improve the confidence and confidence of staff (e.g. training, coaching, data systems).  This is all part of establishing a new site, community and organizational climate and culture.


Practice Tip

 

A Practice Profile will support this process. Using this tool helps to identify the essential functions or core components of a program and describe key activities associated with each component. Creating Practice Profiles enables a program to be teachable, learnable, and doable in typical service settings. The Practice Profile also includes examples of three levels of fluency for guidance: expected (fluent), developmental (heading in the right direction) and unacceptable (off track).

Usable Innovations

Before implementing a selected practice or program, it’s important to have a clear definition of the program Defining an innovation in sufficient detail allows the organization to train staff and administrators to implement it with fidelity; replicate it across all sites; and observe and measure the use of the innovation.

See Lesson 3: Practice Profiles on the AI Hub for more details

Implementation Drivers


Practice Tip

 

It often is necessary to revisit the Installation Stage after Initial Implementation begins as additional roadblocks appear.

Selecting staff, identifying sources for training and coaching, providing initial training for staff, finding or establishing fidelity assessment tools, locating office space, assuring access to materials and equipment, and so on are among the resources that need to be in place before the work can be done effectively (Fixsen et al. 2005; Saldana et al., 2012). During the Installation Stage, Implementation Teams work together to secure the availability of these resources, including the development of their organization’s implementation infrastructure. These activities and their associated “start-up costs” (which may add to first year costs) are necessary first steps to begin any implementation of a new practice or innovation. 

"All organizations [and systems] are designed, intentionally or unwittingly, to achieve precisely the results they get." (Darling, 2005).
From an implementation perspective, we know that successful and sustainable implementation of evidence-based programs always requires organization and systems change.  Some of the work needed to promote this change includes selecting and/or repurposing of staff, scheduling team meetings, aligning policies and procedures, purchasing equipment, finding space and developing the competence of those bringing the changes to staff members.  Any of this work that can be done before the Initial Implementation Stage will reduce the number of potential problems later. 

Video Vignette 27: Case Example - Installation Stage

An example of a Head Start program moving through through implementation stages to enhance practices to ensure sustainable achievement of program standards.


Transcript

Select the first practitioners

Who is qualified to carry out the evidence-based practice or program?  The Installation Stage includes identifying specific behavioral characteristics needed to carry out the work, then developing methods for recruiting and selecting practitioners with those characteristics and with the necessary pre-requisite knowledge and/or skills.  At any level of the organization, this decision of “who goes first” must be made: Which sites, which organization staff members, which Regional Implementation Team, which content experts and practitioners have the most potential or at least can be developed quickly?  Careful consideration and mutual selection at this point will reduce potential “push-back” as the harder work begins.  Just remember, the person who is first to volunteer may not be the optimal choice!

Develop selection protocols

Selection of the leaders and early practitioners for your current (and future) improvement initiatives will be crucial to successful use of the innovation.  To expedite this selection process, the development of selection and/or interviewing protocols to use as screening devices will be helpful.  Prior to actually selecting staff, the process will develop consensus in the group regarding the skills and characteristics that are necessary.  A protocol will keep the focus on specific criteria, keep the process consistent, and make it more likely for choices to be acceptable to the whole group.  If necessary, it may also make it easier to later explain why someone was (or was not) selected. Once created, the protocol can continue to support Teams in selection activities for future work. 

For more information on using the Selection Driver during the Installation Stage, see Module 2: Implementation Drivers.


Practice Tip

 

Remember to include administrators in trainings since they are responsible for supervision and will be visiting sites that use these strategies!  Administrators are responsible for creating ‘hospitable’ environments that allow the new innovation or practices to be used as intended.  They need to understand what it takes to use the program or practice as intended.

Develop Training Plan and Train the First Cohort

Practitioners (and others) at an implementation site need to learn when, where, how, and with whom, to use new approaches and new skills.  Content knowledge, rationales, practice opportunities, and careful attention to adult learning strategies are all components of this plan.  It is also critical to design or use existing assessments of practitioner performance during training as well as assessments related to the overall effectiveness of the training.  This information informs the degree to which practitioners need additional training and coaching. It also will highlight changes that may improve future trainings.  Skill-based training must occur before we can expect practitioners to begin using the new programs or practices.

Develop Coaching Plan

From the research of Bruce Joyce and Beverly Showers (2002), we have learned how important coaching is to promote actual use of innovations in the service setting by practitioners so that consumers can actually benefit from these strategies.  Review the table below.  Note the difference Coaching makes in terms of actual use of an innovation in the classroom.

Table 4.1 Percent of Participants Who Demonstrate Knowledge, Demonstrate New Skills in a Training Setting, and Use New Skills in the Classroom Outcomes

  Outcomes
Training Components Knowledge    Skill Demonstration Use in Classroom
Theory and Discussion 10% 5% 0%
+ Demonstration in Training 30% 20% 0%
+ Practice & Feedback in Training 60% 60% 5%
+ Coaching in Classroom 95% 95% 95%

 (Joyce and Showers, 2002)

Since strategies practitioners use on site involve skills of varying complexity, it is not enough to know a strategy.  They must be able to use it with fluency in order to get positive student outcomes.  Coaching provides “craft” information along with advice, encouragement, and opportunities to practice and use skills specific to the innovation.

Improvement Cycles

Implementation Teams gather data during the Installation Stage to ensure that general and innovation-specific capacities are sufficient to begin implementation confidently, and that communication is happening as intended both within and between levels of the organization, team members and
key stakeholders.

Evaluate readiness of data systems

To evaluate success of an innovation, an organization must examine both how it affects recipient outcomes and determine the fidelity of the use of the innovation by the practitioners.  If there is only marginal (or no) improvement, does this mean the innovation itself is the problem?  Or is the problem that the implementation of the innovation was not effective?  A system designed to quickly and effectively capture both fidelity and outcome data can provide an answer that question.  Once established, the decision support data system provides data that are reliable, valid, accessible for decision-making, and support frequent use of data during the implementation process.

Establish communication links and protocols

Regularly scheduled, frequent, formal, transparent, and accurate communication between and among the practice level (e.g., program/ site) and the policy level (e.g., Organization/Community/State) creates an opportunity to continuously examine and improve the process of implementation.  Through these communication links, teams can use Plan-Do-Study-Act (PDSA) cycles to quickly troubleshoot issues as they arise at the local level and remove roadblocks that slow or derail use of new strategies.  Implementation Teams use improvement cycles to rapidly solve problems help keep the focus on using the innovation to improve individual outcomes. 

More systemic issues and challenges involving multiple organizational levels also benefit from a linked communication process.  This process of creating and then using communication feedback loops for Policy Enhanced Practices and Practice Informed Policies helps create a more aligned system that supports new ways of work.  Module 5: Improvement Cycles provides more information about using Improvement Cycles (PDSA cycles) to engage in making purposeful and functional change.